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Breast feeding
(Matt Daigle, Mothering magazine contest winner 2006)]] Breast feeding or Breastfeeding is the feeding of an infant or young child with milk from a woman's breasts. Babies have a sucking reflex that enables them to suck and swallow milk. With virtually no exceptions, human breast milk is the best source of nourishment for human infants. However, experts disagree about how long to breastfeed to gain the greatest benefit, and how much more risk is involved in using artificial formulas. A mother may breastfeed her infant, or another infant, e.g., as a wet nurse. While there are conflicting studies about the relative value of artificial feeding, including infant formula, it is acknowledged to be inferior to breastfeeding for both full term and premature infants. In many countries, including the First World, artificial feeding is associated with more deaths from diarrhoea in infants . National governments and international organizations promote breastfeeding as the best method of feeding infants in their first two years and beyond. The World Health Organization (WHO) and the American Academy of Pediatrics (AAP) also promote breastfeeding. Regulating authorities recognize the superiority of breastfeeding but also try to make artificial feeding safer. __TOC__ Lactation The production, secretion and ejection of milk is called lactation. It is one of the defining features of being a mammal. Breast milk Not all the properties of breast milk are understood, but its nutrient content is relatively stable. Breast milk is made from the nutrients in the mother's bloodstream and bodily stores. Some studies estimate that a woman who breastfeeds her infant exclusively uses 400 - 600 extra calories a day in producing milk. The composition of breast milk and amount of water, fat and other nutrients varies depending on the manner in which the baby nurses and the mother's food consumption and environment. Foremilk, released at the beginning of a feed, is watery, low in fat and high in carbohydrates. Hindmilk, released as the feed progresses, is creamier. There is no sharp distinction between foremilk and hindmilk and the transition from one to the other is very gradual. The fat content of the milk is primarily determined by the emptiness of the breast—the less milk in the breast, the higher the fat content. The breast can never be truly "emptied" since milk production is continuous. Benefits Breastfeeding benefits mother and child both physically and psychologically. While nutrients and antibodies pass to the baby, beneficial hormones are released into the mother's body. The bond between baby and mother can also be strengthened during breastfeeding. Benefits for the infant The benefits of breastfeeding babies are well documented. The American Academy of Pediatrics states, ::—American Academy of Pediatrics policy statement Breastfed babies have a lower risk of sudden infant death syndrome. Arousal from sleep is believed to be an important survival mechanism that may be impaired in victims of SIDS. Forty three healthy term infants were studied using daytime polysomnography (a record of a person’s sleep patter, breathing, heart activity, and limb movements during sleep) during three periods of 2-4 post term weeks, 2-3 months post term, and 5-6 months post term. In the study, measurements of arousal threshold in response to nasal air jet stimulation were made in both active sleep (AS) and quiet sleep (QS). Arousal thresholds and sleep period lengths were compared between formula fed and breast fed infants at each age. From their research, they concluded that breastfed infants are more easily aroused from AS at 2-3 months of age compared to formula fed infants. This age is at the same time as peak incidences of SIDS Gartner, L., Morton, J., Lawrence, R., Naylor, A., O’Hare, D., Schanler, R., & Eidelman, A. (2005). Breastfeeding and the use of human milk. Pediatrics, 115(2), 496-506. Breastfeeding is associated with lower risk of the following disease: *Allergies 17,046 infants participated in a study that tested whether breastfeeding helped lower the risk of allergies. 13,889 (81.5%) were followed up after 6.5 years. Allergy symptoms were discovered with the international study of asthma and allergy in childhood (ISAAC) questionnaire. The pediatricians also did skin prick tests to five antigens: house dust mite, cat, birch pollen, mixed northern grasses, and Alternaria. They found a significant increase in positive skin prick test results with exclusive breastfeeding for 3 to <6 moths and = or >6 months versus <3 months for the five antigens. They concluded that their results do not support a protective effect of prolonged and exclusive breastfeeding for allergies Kramer, M., Matush, L., Vanilovich, I., & Platt, R. (2007). Effect of prolonged and exclusive breastfeeding on risk of allergy and asthma: cluster randomized trial. BMJ, 335. *Asthma Oddy’s research showed that it was the age that other milk was introduced rather than the duration of breast feeding that was more closely associated with asthma or atopy at age 6 years. Delaying the introduction of milk other than breast milk until at least 4 months of age will protect against asthma and atopy later in childhood. An increased duration of exclusive breast feeding may help to reduce the morbidity and prevalence of childhood asthma. W H Oddy, senior research officer http://www.bmj.com/cgi/content/full/319/7213/815 Asthma BMJ 1999 *Autoimmune thyroid diseases Detailed feeding histories of 59 children with autoimmune thyroid disease, their 76 healthy siblings, and 54 non-related healthy control children were collected. There was no difference in the frequency or duration of breastfeeding among the three groups. Among the children with the disease, the frequency of soy-based milk formulas is significantly higher. They had a prevalence of 31% as compared to their siblings at 12% and the healthy children at 13%. They conclude that there is an association between soy formula feedings in infancy and autoimmune thyroid disease. Fort P, Moses N, Fasano M, Goldberg T, Lifshitz F (1990). "Breast and soy-formula feedings in early infancy and the prevalence of autoimmune throid disease in children". J Am Coll Nutr 9(2):164-7. PMID 2338464 *Bacterial meningitis In a study performed between July 1983-June 1984 102 children under the age of 5 were observed. Researchers found an association between bacterial meningitis, household crowding and day-care attendance. 50% of all the bacterial meningitis that occurred during the study was due to exposure to day-care. Breast feeding was protective for infants under 6 months of age. Cochi, S., Fleming, D., Hightower, A., Limpakarnjarnarat, K., Facklam, R., Smith, J., Sikes, R., & Broome, C. (1986). Primary invasive haemophilus influenze type b disease: a population-based assessment of risk factors. J Pediatr., 108(6). According to another study, infected children with the disease were more likely to have attended day-care. Of 146 infants in the test group, 121 had positive cultures for the infection. The children who were 6 months or younger and had the infection were significantly less likely to have been breastfed. Istre, G., Conner, J., Broome, C., Hightower, A., & Hopkins, R. (1985). Risk factors for primary invasive haemophilus influenza disease: increased risk from day care attendance and school-aged household members. J Pediatr., 106(2). *Celiac disease A systematic review and meta-analysis of observational studies published between 1966 and June 2004 was done to examine the association between breastfeeding and the development of Celiac disease (CD). All the included studies found an association between increasing duration of breastfeeding and decreased risk of developing CD. They concluded that breastfeeding may offer protection against the development of CD. It is however, not clear from the primary studies whether breastfeeding delays the onset of symptoms or provides a permanent protection. Akobeng A, Ramanan A, Buchan I, Heller R(2006). "Effect of breast feeding on risk of coeliac disease: a systematic review and meta-analysis of observational studies". Arch Dis Child 91(1):39-43. PMID 16287899 *Diabetes In a study done, 80 diabetic children were compared to 85 non-diabetic children to see if environmental factors had an effect on the risk of being an insulin-dependent diabetic. Early exposure was defined as the ingestion of food sources other than maternal milk before 3 months of age. They found that fewer children were exclusively breast fed in the diabetic group than in the control group. The diabetic group was also exposed to cow’s milk and solid foods earlier than the control group. They state that a shorter duration of breastfeeding and early exposure to cow’s milk and solid foods may be an important factor in the development of insulin-dependent diabetes. Perez-Bravo, F., Carrasco, E., Gutierrez-Lopez, M., Martinez, M., Lopez, G., & de los Rios, M. (1996). Genetic predisposition and environmental factors leading to the development of insulin-dependent diabetes mellitus in Chilean children. J Mol Med., 74(2). *Diarrhea Morbidity data was collected by weekly monitoring of the first two years of life in 46 infants who were breastfed 41 infants who were formula fed. They found that in the first year of life the incidence of diarrheal illness among breastfed infants was half that of formula fed infants. In the second year of life the mean duration of diarrheal illness was longer in formula fed infants. Their results indicate that the reduction of morbidity associated with breastfeeding will help lower diarrheal illness. Dewey, K., Heinig, M., & Nommsen-Rivers, L. (1995). Differences in morbidity between breast-fed and formula-fed infants. J Pediatr., 126(5). *Eczema 198 infants were monitored from birth to 4 ½-5 years of age to observe the effects of feeding choice. A higher incidence of eczema showed in infants with an immediate family history of atopy. Pratt also found that an incidence of eczema fell in those same infants when exclusive breastfeeding was continued beyond 12 weeks. Regardless of their atopic family history, when breastfeeding was combined with other foods and continued beyond 12 weeks, an incidence of eczema rose in all breastfed infants. Pratt H (1984). "Breastfeeding and eczema". Early Hum Dev 9(3): 283-90. PMID 6734490 *Necrotizing enterocolitis Necrotizing enterocolitis, or an acute inflammatory disease that occurs in the intestines is typically found in premature infants. Of 926 infants in the study, 51 or 5.5% developed the disease. The research done found that in exclusively formula fed infants the disease was 6-10 times more common than in those only breastfed and 3 times more common in those who were formula fed and breastfed. Infants born at 30 weeks’ gestation confirmed the disease was rare in those whose diet included breast milk. Lucas, A., & Cole, T. (1990). Breast milk and neonatal necrotizing enterocolitis. Lancet.,336(8730). *Obesity Armstrong and Reilly Armstrong, J., & Reilly, J. (2002). Breastfeeding and lowering the risk of childhood obesity. Lancet, 359. tested the effects of breastfeeding on obesity. Obesity was defined as body-mass index at the 95th and 98th percentiles or higher. The prevalence of obesity was significantly lower in breastfed children. The meta-analysis done by Arenz, Rucherl, Koletzko, and von Kries Arenz, S., Ruckerl, R., Koletzko, B., & von Kries, R. (2004). Breast-feeding and childhood obesity—a systematic review. Int J Obes Relat Metab Disord., 28(10). also found that breastfeeding reduced the risk of obesity. *Otitis media (ear infection) Healthy infants were monitored every 2-4 weeks until they were 2 years old for the development of Otitis media (OM). They found that a shorter duration of breastfeeding, increased packs of cigarettes smoked per day in the home, and increased hours per week at daycare increased the amount of time with OM. Decreasing these things will help to decrease the infant’s time of having OM in the first two years of life. Owen, M., Baldwin, C., Swank, P., Pannu, A., Johnson, D., & Howie, V. (1993). Relation of infant feeding practices, cigarette smoke exposure, and group child care to the onset and duration of otitis media with effusion in the first two years of life. J Pediatr. 123(5). In a study done by Dewey, Heinig, & Nommsen-Rivers they found that the percentage with any otitis media was 19% lower and with prolonged episodes (>10 days) was 80% lower in breastfed compared with formula fed infants. The mean duration of episodes of otitis media was also longer in formula fed than breastfed infants. Dewey, K., Heinig, M., & Nommsen-Rivers, L. (1995). Differences in morbidity between breast-fed and formula-fed infants. J Pediatr., 126(5). *Respiratory infection and wheezing A study that followed infants who were breastfed and infants who were formula fed found that breastfeeding will help reduce upper respiratory symptoms. Mothers were given a calendar to report any signs of infection on and they found that the infants who were breastfed had fewer days of upper respiratory symptoms after 1 month and after 7 months. Blaymore Bier, J., Oliver, T., Ferguson, A., & Vohr, B. (2002). Human milk reduces outpatient upper respiratory symptoms in premature infants during their first year of life. J Perinatol., 22(5). *Urinary tract infection To see whether breastfeeding has an effect on lowering the risk of a urinary tract infection (UTI), researchers performed a case control study. They also obtained the duration of exclusive breastfeeding for both groups. They concluded that a longer duration of breastfeeding will better reduce the risk of a UTI. Breastfeeding gives the strongest defense against a UTI when done directly after birth. Its defense decreased around 7 months of age. Marild, S., Hansson, S., Jodal, U., Oden, A., & Svedberg, K. (2004). Protective effect of breastfeeding against urinary tract infection. Acta Paediatr. 93(2). Breast milk has several anti-infective factors, including the anti-amoebic factor BSSL, (Rodriquez-Palmero, Koletzko, Kunz, & Jensen, 1999), lactoferrin, the second most common protein in human milk, that binds to iron and inhibits the growth of intestinal bacteria like E. coli and Salmonella Rodriguez-Palmero, M., Koletzko, B., Kunz, C., & Jensen, R. (1999). Nutritional and biochemical properties of human milk: II. Lipids, micronutrients, and bioactive factors. Clinics in Perinatology, 26(2), 335-359., and IgA’ which protects breastfeeding infants from microbial infection. Glass, R., Svennerholm, A., Stoll, B., Khan, M., Hossain, K., Hug, M., & Homgren, J. (1983). Protection against cholera in breast-fed children by antibodies in breast milk. New England Journal of Medicine, 308(23). Breast milk contains the right amount of the amino acids cystine, methionine, and taurine that are essential for neuronal (brain and nerve) development. A New Zealand study took 280 infants and assessed them at the 7-8 years of age on their verbal and performance IQ. Researchers also asked the mothers if they had breastfed or not and for how long. 37% of the mother’s had breastfed for 4 months or longer. Children who were breastfed for 8 months or longer had mean verbal IQ scores that were 10.2 points higher and performance IQ scores that were 6.2 points higher than children who were not breastfed. Their data suggests that breastfeeding may have long term effects on children’s cognitive development. Horwood, L., Darlow, B., & Mogridge, N. (2001). Breast milk feeding and cognitive ability at 7-8 years. Arch Dis. Child Fetal Neonatal Ed., 84. Exclusive breastfeeding may reduce the risk of HIV transmission from mother to child. A case- control study was done on HIV infected Tanzanian women and their children to determine the effects of breastfeeding on transmitting the disease from mother to child. Researchers collected blood samples from the children at birth, 6 weeks after birth, and then every 3 months after that. They also collected breast milk samples from the mother’s and tested the fatty acid (FA) concentration. They found the percentage weight concentrations of two FA’s, lauric acid (12:0) and pentadecanoic acid (15:0) would increase the risk of HIV transmission. A higher percentage weight concentration of gondoic acid decreased the risk of transmission. They concluded that only if the milk has a higher concentration of gondoic acid and other helpful FA’s then it might reduce the risk of transmission from mother to child. Villamor, E., Koulinska, I., Furtado, J., Baylin, A., Aboud, S., Manji, K., Campos, H., & Fawzi, W. (2007). Long-chain n-6 polyunsaturated fatty acids in breast milk decrease the risk of HIV transmission through breastfeeding. American Journal of Clinical Nutrition, 86(3). Unlike human milk, the predominant protein in cow's milk is beta-lactoglobulin, an important factor in cow milk allergies. Benefits for the mother Breastfeeding is the most cost effective. It provides optimal nourishment for a child at the cost of a little extra food for the mother; infant formulas are much more expensive. Breastfeeding releases the hormones oxytocin and prolactin. These relax the mother and make her feel more nurturing toward her baby. Breastfeeding soon after giving birth increases oxytocin levels in the mother. This makes her uterus contract more quickly and reduces bleeding. Oxytocin is similar to pitocin, a synthetic hormone used to make the uterus contract. As fat accumulated during pregnancy is used to produce milk, breastfeeding can help mothers lose weight. While frequent and exclusive breastfeeding can delay the return of ovulation, and therefore fertility, it is not recommended as a sole form of fertility regulation without careful and skillful observation of a combination of other fertility signs, such as cervical fluid, cervical position and texture, basal body temperature, and commercial predictor kits. Ovulation returns before menstruation does, and women can become pregnant before menstruation returns. Breastfeeding is possible throughout pregnancy, but generally milk production will be reduced at some point during the pregnancy. Breastfeeding mothers have less risk of breast, ovarian, and endometrial cancer, and less risk of osteoporosis. Mothers who breastfeed longer than eight months have better bone re-mineralisation. Breastfeeding diabetic mothers require less insulin . Breastfeeding helps stabilize maternal endometriosis,, there is less risk of post-partum hemorrhage, and less risk and beneficial effects on insulin levels for mothers with polycystic ovary syndrome. Some breastfeeding women have pain from thrush or staph infections of the nipple. With continued breast feeding and treatment these can be easily managed and be of little concern for mother and child. Bonding The hormones released during breastfeeding strengthen the maternal bond, the nurturing feelings the mother has towards her child. This is very important as up to 80% of mothers suffer from some form of postpartum depression, though most cases are very mild. The woman's partner and other caregivers can support her in a variety of ways and this support is an important factor in successful breastfeeding. Teaching partners how to manage common difficulties is associated with higher breastfeeding rates. Breastfeeding can affect family relationships. While some partners may feel left out when the mother is feeding the baby, others find breastfeeding strengthens family bonds. Looking after a new baby and breastfeeding take time. This can add pressure to the family, as the partner has to care for the mother as well as doing tasks she would otherwise do. However, as partners are often very willing to give this support, this pressure can help to strengthen the couple's pair bond and also to build the paternal bond to the new member of the family. If the mother is away, an alternative caregiver may be able to feed the baby with expressed breast milk (EBM). The various breast pumps available for sale and rent help working mothers to feed their babies breast milk for as long as they want. However, the mother must produce and store enough milk to feed the child for the time she is away and this may not always be practical. Also, the other caregiver must be comfortable in handling breast milk. These two factors may prompt the mother - perhaps against her wishes - to give up breastfeeding. Recommendations and research The World Health Organization advises: World Health Organization, "Global strategy for infant and young child feeding," section titled "EXERCISING OTHER FEEDING OPTIONS" 24 November 2001 Breastfeeding difficulties Despite being a natural human activity, breastfeeding difficulties are not uncommon. Putting the baby to the breast as soon as possible after birth helps to avoid many difficulties. The AAP breastfeeding policy says: Delay weighing, measuring, bathing, needle-sticks, and eye prophylaxis until after the first feeding is completed. Many breastfeeding difficulties can be resolved with proper hospital procedures, properly trained midwives, doctors and hospital staff, and lactation consultants. There are few cases where breastfeeding is contraindicated. Infant weight gain Breastfed infants generally gain weight according to the following guidelines: :0–4 months: 170 grams per week† :4–6 months: 113–142 grams per week :6–12 months: 57–113 grams per week :† It is acceptable for some babies to gain 113–142 grams (4–5 ounces) per week. This average is taken from the lowest weight, not the birth weight. The average breastfed baby doubles birth weight in 5–6 months. By one year, the typical breastfed baby will weigh about 2½ times birth weight. At one year, breastfed babies tend to be leaner than bottle fed babies. By two years, differences in weight gain and growth between breastfed and formula-fed babies are no longer evident. Methods and considerations There are many books and videos to advise mothers about breastfeeding. Lactation consultants in hospitals or private practice, and volunteer organizations of breastfeeding mothers such as La Leche League also provide advice and support. Early breastfeeding In the half hour after birth, the baby's suckling reflex is strongest, and the baby is more alert, so it is the ideal time to start breastfeeding. Widstrom AM, Wahlberg V, Matthiesen AS, Eneroth P, Uvnas-Moberg K, Werner S, et al. Short-term effects of early suckling and touch of the nipple on maternal behavior. Early Hum Dev 1990; 21:153-63. . Early breast-feeding is associated with fewer nighttime feeding problems Renfrew MJ, Lang S. Early versus delayed initiation of breastfeeding. In: The Cochrane Library CD-ROM. Oxford: Update Software;1998. Time and place for breastfeeding Breastfeeding at least once every two to three hours helps to keep up the milk production. For most women, eight breastfeeding or pumping sessions every 24 hours keeps their milk production high. Newborn babies may feed more often than this: 10 to 12 breastfeeding sessions every 24 hours is common, and some may even feed 18 times a day. Feeding a baby on demand (sometimes referred to as "on cue"), may mean breastfeeding much more than the recommended minimum. Feeding when the baby shows early signs of hunger, is the best way to maintain milk production and ensure the baby's needs for milk and comfort are being met. However, it may be important to recognize whether a baby is truly hungry, as breastfeeding too frequently may mean the child receives a disproportionately high amount of foremilk, and not enough hindmilk, potentially creating problems. . Babies usually show they are hungry by waking up (newborns), mouthing their fists, moaning or fussing. Crying is a late indicator of hunger. When babies' cheeks are stroked, the rooting instinct makes them move their face towards the stroking and open their mouth. Breastfeeding can make mothers thirsty, especially at first, when both mother and baby are inexperienced and when feeding sessions can last for an hour or more (there is no time limit for breastfeeding). Having water readily available helps mothers maintain proper hydration. Most states now have breastfeeding laws which allow a mother to breastfeed her baby anywhere she is allowed to be. In hospitals, rooming-in care is used for breastfeeding. There are breastfeeding rooms in some places, including hypermarkets. Latching on, feeding and positioning When the nipple strokes the baby's cheek the baby will open its mouth and turn towards the nipple. So that the baby will latch on well, the nipple should be pushed into its mouth so that the baby has a mouthful of nipple and areola. The nipple should be at the back of the baby's throat, with the baby's tongue lying flat in its mouth. Inverted or flat nipples can be massaged so that the baby will have more to latch onto. Many women wear nursing brassieres for easier access to the breast, but these are not always necessary and certainly not required. In the very early days, wearing a nursing bra can make breastfeeding complicated and uncomfortable. Wearing a bra at any time after birth will not affect how the breast changes with pregnancy and breastfeeding. Many women find that the size of their breasts change dramatically and so fitting a bra is better done after childbirth rather than before. An ill-fitting bra, whether designed for nursing or otherwise, can cause plugged ducts or mastitis. Pain in the nipple or breast is linked to incorrect breastfeeding techniques. Failure to latch on is one of the main reasons for ineffective feeding and can lead to infant health concerns. A 2006 study found that inadequate parental education, incorrect breastfeeding techniques, or both were associated with higher rates of preventable hospital admissions in newborns. The baby may pull away from the nipple after a few minutes or after a much longer period of time. Normal feeds at the breast can last a few sucks (newborns), from 10 to 20 minutes or even longer (on demand). Sometimes, after the finishing of a breast, the mother may offer the other breast. The length of feeds varies a lot. Regardless of the time taken, the breastfeeding mother should be comfortable. *Upright: The sitting position with the back straight and leaning back comfortably. *Mobile: The mother carries her nursling in a sling or other baby carrier while breastfeeding. Doing so permits the mother to incorporate breastfeeding into the varied work of daily life *Lying down: Good for night feeds or for those who have had a caesarean section **On her back: Mother is usually sitting slightly upright; particularly useful for tandem breastfeeding (nursing more than one child) **On her side: The mother and baby lie on their sides *Hands and knees: The mother is on all fours with the baby underneath her (not usually recommended) While most women breastfeed their child in the cradling position, there are many ways to hold the feeding baby. It depends on the mother and child's comfort and the feeding preference of the baby. Some babies prefer one breast to the other, but the mother should offer both breasts at every nursing with her newborn. *Cradling positions: **Cradle hold: The baby is held with its head in the woman's elbow horizontally across the abdomen, "tummy to tummy", with the woman in an upright and supported position image **Cross-cradle hold: As above but the baby is held with its head in the woman's hand *Football hold: The woman is upright and the baby is held securely under the mother's arm with the head cradled in her hands. This position is especially useful for feeding twins simultaneously image *Feeding up hill: The baby lies stomach to stomach with the mother who is lying on her back; this is helpful for babies finding it difficult to feed *Lying down: **On its side: The mother and baby lie on their sides **On its back: The baby is lying on its back (cushioned by something soft) with the mother on her hands and knees above the child (not usually recommended) When tandem breastfeeding, the mother is unable to move the baby from one breast to another and comfort can be more of an issue. As tandem breastfeeding brings extra strain to the arms, especially as the babies grow, many mothers of twins recommend the use of more supporting pillows. Favored positions include: *Double cradle hold *Double clutch hold image *One clutched baby and one cradled baby *Lying down Exclusive breastfeeding Exclusive breastfeeding is when an infant receives no other food or drink, or even water, besides breast milk. National and international guidelines recommend that all infants be breastfed exclusively for the first six months of life. It is generally accepted that newborns should be exclusively breastfed for around 6 months. Breastfeeding may continue with the addition of appropriate foods, for two years or more. Exclusive breastfeeding has dramatically reduced infant deaths in developing countries by reducing diarrhea and infectious diseases. Exclusively breastfed infants feed anywhere from 6 to 14 times a day. Newborns consume from 30 to 90 ml (1 to 3 US fluid ounces). After the age of four weeks, babies consume about 120ml (4 US fluid ounces) per feed. Each baby is different, but as it grows the amount will increase. It is important to recognize the baby's hunger signs. It is assumed that the baby knows how much milk it needs and it is therefore advised that the baby should dictate the number, frequency, and length of each feed. The supply of milk from the breast is determined by the number and length of these feeds or the amount of milk expressed. The birth weight of the baby may affect its feeding habits, and mothers may be influenced by what they perceive its requirements to be. For example, a baby born small for gestational age may lead a mother to believe that her child needs to feed more than if it larger; they should, however, go by the demands of the baby rather than what they feel is necessary. While it can be hard to measure how much food a breastfed baby consumes, babies normally feed to meet their own requirements. Babies that fail to eat enough may exhibit symptoms of failure to thrive. If necessary, it is possible to estimate feeding from wet and soiled nappies (diapers): 8 wet cloth or 5–6 wet disposable, and 2–5 soiled per 24 hours suggests an acceptable amount of input for newborns older than 5–6 days old. After 2–3 months, stool frequency is a less accurate measure of adequate input as some normal infants may go up to 10 days between stools. Babies can also be weighed before and after feeds. Expressing breast milk When direct breastfeeding is not possible, a mother can express (artificially remove and store) her milk. With manual massage or using a breast pump, a woman can express her milk and keep it in freezer storage bags, a supplemental nursing system, or a bottle ready for use. Breast milk may be kept at room temperature for up to ten hours, refrigerated for up to eight days or frozen for up to four to six months. Research suggests that the antioxidant activity in expressed breast milk decreases over time but it still remains at higher levels than in infant formula. Expressing breast milk can maintain a mother's milk supply when she and her child are apart. If a sick baby is unable to feed, expressed milk can be fed through a nasogastric tube. Expressed milk can also be used when a mother is having trouble breastfeeding, such as when a newborn causes grazing and bruising. If an older baby bites the nipple, the mother's reaction - a jump and a cry of pain - is usually enough to discourage the child from biting again. (Another possibility is responding to the bite by drawing the baby so close that his nose is covered and he cannot breathe without releasing.http://www.parenting.com/parenting/baby/article/0,19840,648157,00.html) Babies or toddlers that are truly feeding cannot physically bite the nipple. "Exclusively Expressing", "Exclusively pumping" and "EPing" are terms for a mother who feeds her baby exclusively on her breastmilk while not physically breastfeeding. This may arise because her baby is unable or unwilling to latch on to the breast. With good pumping habits, particularly in the first 12 weeks when the milk supply is being established, it is possible to produce enough milk to feed the baby for as long as the mother wishes. Kellymom http://www.kellymom.com/bf/pumping/bf-links-excpumping.html has a page of links relating to exclusive pumping. It is generally advised to delay using a bottle to feed expressed breast milk until the baby is 4-6 weeks old and is good at sucking directly from the breast. Because It takes less effort to suck from a bottle, a baby might lose its desire to suck from the breast. This is called nursing strike or nipple confusion. To avoid this when feeding expressed breast milk (EBM) before 4-6 weeks of age, it is recommended that breast milk be given by other means such as feeding spoons or feeding cups. Also, EBM should be given by someone other than the breastfeeding mother (or wet nurse), so that the baby can learn to associate direct feeding with the mother (or wet nurse) and associate bottle feeding with other people. Some women donate their expressed breast milk (EBM) to others, either directly or through a milk bank. Though some dislike the idea of feeding their own child with another woman's milk, others appreciate being able to give their baby the benefits of breast milk. Feeding expressed breast milk—either from donors or the baby's own mother—is the feeding method of choice for premature babies. Mixed feeding Predominant or mixed breastfeeding means feeding breast milk along with infant formula, baby food and even water, depending on the age of the child. Babies feed differently with artificial teats than from a breast. When feeding from the breast, the tongue massages the milk out rather than sucking, and the nipple does not go as far into the mouth; when feeding from a bottle, an infant will suck harder and the milk may come in more rapidly. Therefore, mixing breastfeeding and bottle-feeding (or using a pacifier) before the baby is used to feeding from its mother can induce the infant to prefer the bottle to the breast. Orthodontic teats, which are generally slightly longer, are closer to the nipple. Some mothers supplement feed with a small syringe or flexible cup to reduce the risk of artificial nipple preference. Tandem breastfeeding Feeding two children at the same time is called tandem breastfeeding The most common reason for tandem breastfeeding is the birth of twins, although women with closely spaced children can and do continue to nurse the older as well as the younger. As the appetite and feeding habits of each baby may not be the same, this could mean feeding each according to their own individual needs, and can also include breastfeeding them together, one on each breast. In cases of triplets or more, it is a challenge for a mother to organize feeding around the appetites of all the babies. While breasts can respond to the demand and produce large quantities of milk, it is common for women to use alternatives. However, some mothers have been able to breastfeed triplets successfully http://www.breastfeeding.asn.au/bfinfo/higher.html http://www.radmid.demon.co.uk/tripletsbf.htm. Tandem breastfeeding may also occur when a woman has a baby while breastfeeding an older child. During the late stages of pregnancy the milk will change to colostrum, and some older nurslings will continue to feed even with this change, while others may wean due to the change in taste or drop in supply. Feeding a child while being pregnant with another can also be considered a form of tandem feeding for the nursing mother, as she also provides the nutrition for two. Extended breastfeeding Breastfeeding past two years is called extended breastfeeding or "sustained breastfeeding" by supporters and those outside the U.S. ) Some women breastfeed a child till the age of 3 or more. Supporters of extended breastfeeding believe that all the benefits of human milk, nutritional, immunological and emotional, continue for as long as a child nurses. Often the older child will nurse infrequently or sporadically as a way of bonding with the mother. Shared breastfeeding In developing nations in Africa, it is sometimes common for more than one woman to breastfeed a child. Shared breastfeeding is a risk factor for HIV infection in infants. A woman who is engaged to breastfeed another's baby is known as a wet nurse. Islam has codified the relationship between this woman and the infants she nurses, and also between the infants when they grow up, so that milk siblings are considered as blood siblings and cannot marry. Weaning Weaning is the process of introducing the infant to ordinary food and reducing the supply of breast milk. The infant is fully weaned once it relies on ordinary food for all its nutrition and it no longer receives any breast milk. Most mammals stop producing the enzyme lactase at the end of weaning, and become lactose intolerant. Many humans have a mutation that allows the production of lactase throughout life and can drink milk - usually cow or goat milk - well beyond the age of weaning.http://www.aafp.org/afp/20020501/1845.html Aapf.org History of breastfeeding Prior to the twentieth century, alternatives to breastfeeding were rare. Attempts in 15th century Europe to use cow or goat's milk were not very positive. In the 18th century, flour or cereal mixed with broth were introduced as substitutes for breastfeeding, but this did not have a favorable outcome, either. True commercial infant formulas appeared on the market in the mid 19th Century but their use did not become widespread until after WWII. As the superior qualities of breast milk became better-established in medical literature, breastfeeding rates have increased and countries have enacted measures to protect the rights of infants and mothers to breastfeed. See also * Attachment parenting * Baby-friendly hospital * Baby-led weaning * Breast shell * Continuum concept * Doula * Erotic lactation * Kathy Dettwyler * Initial formation of the human maternal bond * Intelligence and breast feeding * Parenting * Sheila Kitzinger * Sleep References Numbered references Unnumbered references * * * * * * * * * * Website references *American Academy of Pediatrics Policy Statement on Breastfeeding *4woman.gov – US Department of Health & Human Services Breastfeeding resource page *Breastfeeding NHS – UK NHS Breastfeeding strategy *Royal Australasian College of Physicians Paediatric Policy: Breastfeeding *American Family Physician Initial Management of Breastfeeding by Keith Sinusas and Amy Galgliardi *Benefits of breastfeeding United States Breastfeeding Committee *Population Reports: Better Breastfeeding, Healthier Lives – Johns Hopkins INFO Project, 2006 *Feminism and Breastfeeding from SignsJournal of Women in Culture and Society 2006, vol. 31, no.2 Infant pain and breastfeeding * American Academy of Pediatrics. Committee on Psychosocial Aspects of Child and Family Health; Task Force on Pain in Infants, Children, and Adolescents. The assessment and management of acute pain in infants, children, and adolescents. Pediatrics. 2001 Sep;108(3):793-7. * Howard CR, Howard FM, Weitzman ML. Acetaminophen analgesia in neonatal circumcision: the effect on pain. Pediatrics. 1994;93(4):641-6. *The Womanly Art of Breastfeeding, Third Edition, July 1981. Pages 92–93 Elective Surgery for you or baby *See also the section on circumcision and breastfeeding in Medical analysis of circumcision Health risks of formula feeding *Health risks of not breastfeeding US Department of Health & Human Services *The Risks of Infant Formula Feeding breastfeeding task force of Greater Los Angeles *Breastfeeding and the Risk of Postneonatal Death in the United States Pediatrics, Vol. 113 No. 5 May 2004 & resulting correspondence *Supplementation of the Breastfed Baby "Just One Bottle Won't Hurt" ...or Will It? by Marsha Walker RN IBCLC (National Alliance for Breastfeeding Advocacy) *Salon.com Formula for disaster by Katie Allison Granju *What should I know about infant formula? Kellymom.com (contains links to other websites) *National Alliance for Breastfeeding Advocacy contains links to other articles including: **Contaminants in Infant Formula **Recalls of Infant Feeding Products External links * Human Milk Secretion: An Overview from the US National Institute of Health * Reports regarding breastfeeding and U.S. law from the Congressional Research Service (CRS) * Breast-Feeding Best Bet for Babies — U.S. Food and Drug Administration article Category:Babycare Category:Breast Category:Breastfeeding Category:Children's rights Category:Feeding practices Category:Human behavior Category:Human development Category:Infant feeding Category:Infancy Category:Interpersonal relationships Category:Parenting Category:Women's rights